1991, 07-09 Permit App 91004058 Mechanical FixturesJOB STREET ADDRESS:
CITY/STATE/ZIP:
OWNER: AC 7 , h'-
MAILING ADDRESS:
likEtIIMMAL PPRN1t1 APPL1tAtM FORM
Infor:ttation Worksheet
geo.)
(Street)/e�
CONTRACTOR. /LI2-&--
MAILING ADDRESS: PC) , 3 -7c
(Street)
PARCEL NUMBER:
PHONE NUMBER: 9,,7e - 90
City/State)
LICENSE NUMBER: Se - / 2
PHONE NUMBER: 989,- //
City/State)
99 c
(Zip),
- 62-3 W7
�7 X 3 /y.
CQ.%zq 9gc()
(Zip)
MECHANICAL WORKSHEET/FEE SCHEDULE
DESCRIPTION NUMBER
OF UNITS
DUCTWORK SYSTEM
WOODSTOVE/INSERT
GAS WATER HEATER
HEATING EQUIPMENT <100,000 BTU
HEATING EQUIPMENT +100,000 BTU
GAS PIPING (1 - 4 OUTLETS)
GAS PIING (5 OR MORE. EACH:)
REFRIG 1-100M BTU (NOT A/C OR HEAT PUMP)
REFRIG 101-500M BTU
REFRIG 501-1,000M BTU
REFRIG 1,001-1,750M BTU
REFRIG +1,750M BTU
HEAT PUMP & AIR CONDITIONER
HEAT PUMP & AIR CONDITIONER
HEAT PUMP & AIR CONDITIONER
HEAT PUMP & AIR CONDITIONER
HEAT PUMP & AIR CONDITIONER
VENTILATING FANS
EVAPORATIVE COOLERS
TYPE I HOOD {PER 12' OR 12' PTN. OF HOOD?
TYPE II HOOD
CLOTHES DRYER
RANGE
GAS LOG
0-3 TONS
3-15 TONS
15-30 TONS
30-50 TONS
+50 TONS
MISCELLANEOUS (NOT COVERED ELSEWHERE)
UNLISTED GAS APPLIANCE <400,000 BTU
UNLISTED GAS APPLIANCE >400,000 BTU
USED APPLIANCE <400,000 BTU
USED APPLIANCE >400,000 BTU
AIR HANDLER <10,000 CFM
AIR HANDLER >10,000 CFM
NOTE: �INIMIIM -E T E IS $35.00
SIGNATURE
SUBTOTAL
X EACH
UNIT
x$10.00 =
x 25.00 =
x 10.00 =
x 12.00 =
x
x 1-�4�-`
x 1.00 =
x 12.00 =
x 20.00 =
x 25.00 =
x 35.00 =
x 60.00 =
x 12.00 =
x 20.00 =
x 25.00 =
x 35.00 =
x 60.00 =
x 10.00 =
x 10.00 =
x 50.00 =
x 10.00 =
x 10.00 =
x 10.00 =
x 10.00 =
x 10.00 =
x 50.00 =
x100.00 =
x 50.00 =
x100.00 =
x 12.00 =
x 15.00 =
PLUS: PROCESSING FEE
EQUALS: TOTAL PERMIT
FEE DUE
Spokane Cuntyr artment of Building and Safety
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675
= AMOUNT
/ 0 . 0 c
0
/. (DO
$ 23 -(e
25.00